Prestroke PT-INR ≥2.00 was associated with a lower likelihood of poor functional outcome at discharge compared to PT-INR <1.50 (OR 0.20; 95% CI 0.06-0.55).
Cohort (n=602)
Does higher prestroke PT-INR (≥2.00) improve clinical outcomes in patients who develop acute cardioembolic stroke while on warfarin?
In patients who develop acute cardioembolic stroke while on warfarin, a prestroke PT-INR ≥2.0 is associated with less severe neurological deficits and more favorable functional outcomes.
Effect estimate: OR 0.20 (95% CI 0.06-0.55)
BACKGROUND AND PURPOSE: The relationship between the intensity of anticoagulation at the onset of acute cardioembolic stroke and clinical outcome after stroke is unclear. Here, we elucidated the relationship between prothrombin time-international normalized ratio (PT-INR) values on admission and clinical outcomes in patients with acute cardioembolic stroke. METHODS: A total of 602 patients from the Fukuoka Stroke Registry in Japan who had been treated with warfarin but developed cardioembolic stroke were enrolled. The patients were classified into 3 groups according to their PT-INR values on admission: PT-INR <1.50, 411 patients; PT-INR 1.50 to 1.99, 146 patients; and PT-INR ≥2.00, 45 patients. The associations between PT-INR categories and severe neurological deficits (National Institutes of Health Stroke Scale ≥10) on admission and poor functional outcome (modified Rankin scale 4-6) at discharge were investigated using a logistic regression analysis. RESULTS: Neurological deficits on admission were less severe, and functional outcome at discharge was more favorable as the PT-INR level on admission increased. The multivariate analysis revealed that severe neurological deficits were inversely associated with PT-INR on admission (PT-INR 1.50-1.99: odds ratio, 0.66; 95% confidence interval, 0.43-1.00; PT-INR ≥2.00: odds ratio, 0.41; 95% confidence interval, 0.20-0.83; compared with a reference group of PT-INR <1.50). Poor functional outcome was less likely in patients with PT-INR ≥2.00 (odds ratio, 0.20; 95% confidence interval, 0.06-0.55) after adjustment for confounders. CONCLUSIONS: Prestroke PT-INR ≥2.0 is associated with favorable clinical outcomes after acute cardioembolic stroke.
Nakamura et al. (Wed,) conducted a cohort in Acute cardioembolic stroke (n=602). PT-INR ≥2.00 on admission vs. PT-INR <1.50 was evaluated on Poor functional outcome (modified Rankin scale 4-6) at discharge (OR 0.20, 95% CI 0.06-0.55). Prestroke PT-INR ≥2.00 was associated with a lower likelihood of poor functional outcome at discharge compared to PT-INR <1.50 (OR 0.20; 95% CI 0.06-0.55).
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